Factors associated with acute pancreatitis in patients with impacted duodenal papillary stones: a retrospective cohort study

Abstract

Objective

Impaction of a stone at the duodenal papilla can obstruct biliopancreatic outflow and thereby lead to acute pancreatitis. But not all patients with an impacted papillary stone (IPS) had the clinical features of pancreatitis. This study aimed to identify factors associated with acute pancreatitis in patients with IPS.

Methods

We retrospectively analyzed patients with IPS who underwent endoscopic retrograde cholangiopancreatography (ERCP) at Tianjin Nankai Hospital. Clinical factors were compared between patients with/without acute pancreatitis before ERCP. Factors associated with acute pancreatitis were identified by univariable and multivariable binary logistic regression.

Results

The final analysis included 174 patients with acute pancreatitis (pancreatitis group, PG) and 130 patients without acute pancreatitis (non-pancreatitis group, NPG). Preoperative incidences of jaundice (85.6 vs. 72.3%), acute cholangitis (54.6 vs. 33.8%), and hyperlipidemia (39.1 vs. 22.3%) were higher in the PG than in the NPG (p < .05). High tension in the duodenal papilla (83.3 vs. 71.5%), circular papillary orifice (82.8 vs. 70.0%), and distal stone impaction (90.8 vs. 82.3%) were more common in the PG than in the NPG (p < .05), whereas stone diameter and common bile duct diameter did not differ significantly between groups. Multivariable logistic regression revealed that jaundice, acute cholangitis, hyperlipidemia, and dot/circular papillary orifice were independently associated with acute pancreatitis (p < .05).

Conclusions

Jaundice, acute cholangitis, and hyperlipidemia are independent risk factors for acute pancreatitis in patients with IPS. Prompt ERCP in patients with these features might reduce acute pancreatitis risk. Dot/circular papillary orifice may be an anatomical factor of acute pancreatitis, which needs more evidence.

Keywords:

• Duodenal papilla
• impacted papillary stone
• acute pancreatitis
• risk factors
• Dot/circular papillary orifice
• Jaundice
• acute cholangitis
• hyperlipidemia

Ethics approval

The Ethics Committee of Tianjin Nankai Hospital of Tianjin Medical University approved the study (No. NKYY_YXKT_IRB_2021_019_01) and waived the requirement for consent due to the retrospective study design.

Consent to participate

Patients provided informed written consent before ERCP.

Author contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Ming Li, Ao Wang, and Ning Li. The first draft of the manuscript was written by Ming Li, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data analyzed in this study are included in the article. Further inquiries can be directed to the corresponding author.